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Omalizumab is effective for the control of urticaria recalcitrant to antihistamines in different populations globally. The ratio of total serum IgE 4-week/baseline ≥2 can predict response with a high likelihood. In observational real-life trials, doses have been adjusted on an individual basis: in some populations, up to two-thirds of the patients can be controlled with 150 mg/month; however, others are still not controlled with 300 mg/month. In these, 150 mg bimonthly could be tried, before up-dosing to 450 mg/month. On the long run (up to 3 years) omalizumab kept its efficacy. In many patients, dosing intervals could be augmented (6-8 weeks, some even more). After a 12-month treatment, about 20% showed long-term remission without relapse. Some biomarkers are being detected. Adjusting omalizumab doses in urticaria patients could enhance efficacy (shortening dosing interval and/or augmenting dose) and save costs (after 12 months: extending dosing interval and/or reducing dose).

Mental health is more affected than physical health in Colombian subjects with respiratory allergy. There was a strong correlation between the mental health domain and the values of PEF in patients with asthma/allergic rhinitis.

Introducción: las enfermedades alérgicas afectan la calidad de vida de quienes las padecen y en los últimos años su prevalencia ha aumentado significativamente. La inmunoterapia con extractos alergénicos es usada para mejorar el curso de la enfermedad; no obstante, aún es necesario conocer su efectividad y seguridad. Objetivo: describir las reacciones adversas sistémicas producidas por la administración de inmunoterapia subcutánea con extractos polimerizados de ácaros. Materiales y métodos: se realizó un estudio de cohorte retrospectivo de pacientes con enfermedad alérgica mediada por IgE que recibieron inmunoterapia subcutánea con extractos polimerizados de Dermatophagoides farinae, Dermatophagoides pteronyssinus y Blomia tropicalis en el servicio de Alergología Clínica de la IPS Universitaria de la Universidad de Antioquia (Medellín, Colombia). Se realizó un análisis descriptivo de las variables demográficas y clínicas y su asociación con el riesgo de reacción adversa sistémica. Resultados: se incluyeron 622 pacientes; 92,8% con diagnóstico de rinitis, 60,3% de asma, 56,9% de conjuntivitis y 19,6% de dermatitis atópica. Un total de 73 (11,7%) pacientes experimentaron reacciones sistémicas adversas (razón de reacción/inyección = 1,06 x 100 inyecciones); de estos 47 (64,4%) recibieron adrenalina intramuscular. El 93,1% de los pacientes presentaron reacciones sistémicas grado 1 y 2. El asma fue el diagnóstico con mayor riesgo de presentar reacción sistémica (riesgo relativo = 1,96). Conclusiones: la inmunoterapia subcutánea con extractos polimerizados de ácaros administrada en pacientes con enfermedad alérgica demostró ser segura. No obstante, debe ser indicada y aplicada por personal clínico experto y advertírsele al paciente sobre los posibles riesgos y efectos adversos.

The frequency of systemic reactions with subcutaneous immunotherapy with Dermatophagoides farinae, Dermatophagoides pteronyssinus and Blomia tropicalis tyrosine-adsorbed extracts was similar to that reported with other extracts.

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RATIONALE: HDR are frequent motives for consultation in Allergology services. Possible etiologic factors and clinical presentation differences between Latin American children and adults have not been described yet. METHODS: An observational cross sectional study using a modified ENDA questionnaire was implemented in 19 allergology units in 11 Latin-American countries, reporting patients presenting HDR in the last year before consultation. Causal relationship was categorized according to WHO-UMC Causality Categories: certain, probable, possible, unlikely and conditional. RESULTS: 727 patients, 144 (19.8%) of them under 18 years old, presented 732 reactions. Female gender was 71.7% in adults, and 50% in children. Atopic history was present in 44.9 and 63.8% and a history of previous drug reaction in 31.9 and 36.9% of adults and children, respectively. Fourteen percent of adult, and 10.7% of children had presented previous reactions with the same drug. The clinical picture of the reaction in adults and children was angioedema in 47.9 and 48.6%, urticaria in 44.5 and 41.8%, maculopapular and macular exanthema in 20.3 and 22.6 %, erythema multiforme and SJS in 3.6 and 2.7% respectively. Certain and probable causal relationships were attributed in adults and children to NSAIDs in 55.7 and 60.3 %, beta lactams in 11.2 and 19.8%, non beta lactam antibiotics in 8.4 and 2.5 %, anticonvulsants in 3.2 and 1.7%, chemotherapy 0.8 and 2.5% of patients, respectively. CONCLUSIONS: Female sex was predominant in adults but not in children. NSAIDs and antibiotics were the drugs implicated in more than 75% of patients. Beta lactam antibiotics were more frequently involved in children.